Empowering communities to collectively abandon FGM/C in Somaliland Baseline Research Report Katy Newell-Jones January - May 2016 Cover image by Katy Newell-Jones: Data collection in Somaliland Written by Katy Newell-Jones on behalf of the Orchid Project, for ActionAid, SOWDA and WAAPO May 2016 ACKNOWLEDGEMENTS This research was led by Katy Newell-Jones for the Orchid Project. Orchid Project would like to thank all who contributed to this research from the ActionAid UK and ActionAid Somaliland teams. Special thanks go to the enumerators, translators, transcribers, coordinators of the data collection and the IT support team (see appendix B). The quality of the data collected was the result of their support, commitment and attention to detail. We are particularly grateful to the support of the staff of ActionAid Somaliland’s partners in Somaliland SOWDA and WAAPO. Their contribution in mobilising the communities, introducing the data collection teams and organising participants for focus group discussions was immensely valuable. We would also like to thank all those who participated in the community survey, focus group discussions and key informant interviews. The research was greatly enhanced by your openness and willingness to share your thoughts on sensitive and at times, challenging issues. We are grateful for the support and participation of the Ministries of Labour and Social Affairs (MoLSA), Religious Affairs (MoRA) and Health (MoH) for their willingness to be interviewed and to provide documentation to help us to understand FGM/C in Somaliland from a governmental and policy maker perspective. Particular thanks go to Edna Adan and colleagues at the Edna Adan University Hospital for support throughout the research including valuable discussions and providing skilled enumerators. This research was made possible through funding from Comic Relief. CONTENTS Executive summary…………………………………………………………………………………………....2 1. Introduction………………………………………………………………………………………………..…4 2. Research aims…………………………………………………………………….………………….….….5 3. The context of FGM/C in Somaliland………………………………….……………………………...…..6 3.1 Review of published data on FGM/C (2006-2016) 3.2 Legal status of FGM/C in Somaliland 3.3 Gaps in existing knowledge 4. Terminology…………………………………………………………………………………………..…....11 5. Research approach…………………………………………………………………………………….…13 5.1 Overall approach 5.2 Methodology 5.3 Quality assurance 5.4 Limitations and constraints of the research 5.5 Data cleaning and analysis 6. Data Collected…………………………………………………………..…..……………………….....…19 7. Research Findings……………………………………………………………...………………………...22 7.1 Prevalence of FGM/C among girls and women 7.2 Communities' knowledge, attitudes and beliefs on FGM/C 7.3 Opinion former perspectives 7.4 Policies and laws relating to FGM/C in Somaliland 8. Discussion of key themes……………………………………………………….…………………….....70 8.1 Recognising the intermediate cut / sunna 2 8.2 Prevalence of female genital cutting 8.3 Differences between FGM/C in urban and rural communities 8.4 Role of religion and religious leaders 8.5 Medicalisation of FGM/C 8.6 Communication and conversations 8.7 Role of men 8.8 Driving forces and decision-making dilemmas 9. Implications for the project………………………………………………….…………………...............79 9.1 Project outcomes and indicators: baseline data 9.2 Recommendations for monitoring, evaluation and learning 10. Conclusion…………………………………………………………….………………………………….85 Appendix A Acronyms Appendix B Research tools and methodology Appendix C Capacity building workshops on ethical research Appendix D Participants interviewed per target community Appendix E Project and non-project communities Appendix F Project outcomes and indicators: baseline data ABBREVIATIONS AAIS ActionAid International Somaliland ACPO Association of Chief Police Officers Alla Amin Alla Amin Women Organisation CCBRS Comprehensive Community Based Rehabilitation in Somaliland CPS Community Perspectives Study CSO Civil Society Organisation DHS Demographics and Health Surveys DRR Disaster Risk Reduction EAUH Edna Adan University Hospital FGC Female Genital Cutting FGD Focus Group Discussion FGM Female Genital Mutilation FGM/C Female Genital Mutilation / Cutting HAVOYOCO Hargeisa Voluntary Youth Committee Horumar Horumar - News and information service about Somalia IDP Internally Displaced Person INGO International non-governmental organisation MCH Mother and Child Health MEL Monitoring, evaluation and learning MICS Multiple Indicator Cluster Survey MoE Ministry of Education MoH Ministry of Health MoI Ministry of Interior MoJ Ministry of Justice MoLSA Ministry of Labour and Social Affairs MoP Ministry of Planning MoRA Ministry of Religious Affairs MoY Ministry of Youth NAFIS Network Against FGM/C in Somaliland Nagaad Nagaad Network NGO Non-governmental organisation NRC Norwegian Refugee Council ODK Open Data Kit SAVE Save the Children SDG Sustainable Development Goals SFHA Somaliland Family Health Association SOWDA Somaliland Women Development Association SRHS Sexual and Reproductive Health Services TBA Traditional Birth Attendant UNFPA United Nations Population Fund UNICEF United Nations Children's Emergency Fund VAWG Violence against women and girls WAAPO Women Action for Advocacy & Progress Organization WASH Water Sanitation and Health WHO World Health Organisation ZT Zero Tolerance 1 EXECUTIVE SUMMARY This research informs the baseline of a 4-year project (2015-2018), Empowering communities to collectively abandon FGM/C in Somaliland, implemented by ActionAid International Somaliland (AAIS) in partnership with Women Action for Advocacy & Progress Organization (WAAPO) and Somaliland Women Development Association (SOWDA). The research took place in 25 communities in two regions of Somaliland, Maroodi Jeex and Togdheer. A participatory, holistic approach was adopted involving 2,132 women, men, boys, girls, religious leaders, health workers, teachers, law enforcers, community leaders, parliamentarians, civil society organisations, national and international agencies. Participants were consulted through a community survey, using mobile data devices, focus group discussions and key informant interviews. This approach is in line with a social norms-based approach which recognises the impact of different stakeholders in decision-making at the individual, household and community levels. This research distinguishes between three types of female genital cut commonly used in Somaliland (table 4A); the pharaonic (WHO FGM type III), the intermediate or sunna 2 (type II) and the sunna (type I). The use of terminology around female genital cutting is fluid with many considering the terms FGM and FGM/C relate only to the pharaonic cut. The research shows that overall prevalence rate among community women in Maroodi Jeex and Togdheer remains high at 99.4%, with 80% having undergone the pharaonic cut. There is evidence of a change away from the pharaonic cut to the intermediate and sunna cuts, with only 34% of girls aged 12-14 years having undergone the pharaonic cut compared to 96% of women aged over 25 years. Just 5% of girls and women are currently cut by health specialists, however, there is widespread evidence of increased medicalisation of cutting, with younger women more likely to have been cut by midwives, nurses or doctors and many religious leaders and some community leaders calling for midwives and nurses to be trained to perform the cut safely and hygienically. There are significant differences between urban and rural communities, with changes taking place at a faster rate in urban communities. This includes trends towards abandonment as well as increases in medicalisation. The principle reason for cutting to continue is that it is a deeply embedded cultural practice, closely linked to proof of virginity for marriage (types II and III) and Islamic law (type I). Most religious leaders oppose the intermediate and pharaonic cuts as harmful, non-Islamic practices but support the sunna cut as honourable under Islamic law. There is a strong expectation in communities for girls to be cut, which is felt more strongly among women (84%) than men (62%). The majority of community members (84%) intend to cut their daughters in the future, with women in particular intending to select a less severe cut than they perceive the community expects them to use. Communication about female genital cutting at household and community levels is low, with just 22% of community members having spoken to others about FGM/C in the last year. Only 16% of community members said that FGM/C had been raised in public meetings. Less than half of religious leaders have participated in private discussions (47%) or spoken in public meetings (45%) on FGM/C. The majority (93%) of community leaders in urban communities have spoken publicly about FGM/C, compared to just 31% from rural communities. Other opinion formers are less actively engaged with 59% of health workers, 38% of teachers and 22% of law enforcers having spoken in public meetings on FGM/C. Only a third of teachers have spoken about female cutting in schools, despite schools in other countries where considerable progress has been made towards abandonment of FGM/C providing important places for young people to learn and talk about the issues around female cutting. 2 Decision-making in relation to female cutting is primarily the responsibility of women, with women facing difficult decisions, wanting their daughters to be socially acceptable and able to marry, yet also wanting them not to suffer the kinds of health complications